Osteochondritis dissecans

Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a condition in which a part of the bone of a joint begins to break loose due to lack of blood flow. A slippery tissue called cartilage that covers the joint also begins to break loose. The condition may cause pain that gets worse over time and a feeling of the joint's motion being blocked.

Osteochondritis dissecans happens most often in school-age children and teens. It may cause symptoms after a single injury to a joint. Or symptoms may appear after doing an activity that greatly loads the joint for several months. This is mainly true for high-impact sports and those that involve cutting and pivoting, such as soccer and basketball.

The condition most often affects the knees. But it also may affect elbows, ankles and other joints. Most often, the condition affects just one joint.

Some people might need surgery for ongoing pain or if the piece of bone and cartilage comes loose and moves around inside the joint.

Depending on the joint that's affected and how far along the condition is, symptoms of osteochondritis dissecans may include:

• Pain. Physical activity may bring on this most common symptom of osteochondritis dissecans. Activity might include walking up the stairs, climbing a hill, running or playing sports.
• Swelling and tenderness. The skin around the joint might be swollen and tender.
• Joint popping or locking. The joint might pop or stick in one place if a loose piece gets caught between bones during movement.
• Joint weakness. The joint might feel weak or like it's "giving way."
• Less range of motion. The affected arm or leg may not straighten all the way.

When to see a doctor

If you or your child has ongoing pain or soreness in the knee, elbow or another joint, see your healthcare professional. Also make an appointment if you or your child has joint swelling or can't move a joint through its full range of motion.

Experts don't know the cause of osteochondritis dissecans. Even a small injury repeated over time might lower blood flow to the end of the affected bone. People with certain genes may be more likely to get the condition.

Osteochondritis dissecans happens mainly in children and teens between the ages of 10 and 20 who are active in sports. Obesity may raise the risk.

Over time, osteochondritis dissecans can raise the risk of getting osteoarthritis at an early age in the affected joint. If not healed all the way, the condition can cause ongoing pain and trouble using the joint.

Learning about the risks to the joints linked with overuse might help teens who play sports. Learning how to move properly in their sports can help lower the chance of injury. So can training for the sports they play, strength training, and exercises that help improve body control and balance.

During a physical exam, a healthcare professional presses on the affected joint, checking for swelling or tenderness. Sometimes it's possible to feel a loose piece of bone and cartilage inside the joint. Your healthcare professional also has you or your child move the joint to check the joint's range of motion.

Health care professionals stage osteochondritis dissecans by the size of the injury, whether the piece of bone and cartilage is partly or totally loose, and whether the piece stays in place.

Imaging tests

One or more of these tests can help diagnose osteochondritis dissecans:

• X-rays. X-rays show the structure of the bone and can show anything that isn't usual in the joint or in the bone.
• MRI. Using radio waves and a strong magnetic field, an MRI can make detailed images of both hard and soft tissues. These include bone and cartilage. If X-rays appear OK but you still have symptoms, you might have an MRI.
• CT scan. This joins X-ray images taken from different angles to make detailed images of structures inside the body. CT scans may help show where the loose fragments are within the joint.

The goal of osteochondritis dissecans treatment is to help the affected joint work well and relieve pain. Treatment also lowers the risk of osteoarthritis. No one treatment works for everyone. In children whose bones are still growing, the bone may heal with rest.

Medications

Nonsteroidal antiinflammatory medicines available without a prescription can give short-term pain relief. They include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve).

Therapy

At first, your healthcare professional may suggest the following:

• Resting the joint. Keep your child from doing activities that stress the joint, such as jumping and running with an affected knee. Your child might need to use crutches for a time, mainly if pain causes limping. Your child also might wear a splint, cast or brace to keep the joint still for a few weeks.
• Physical therapy. This therapy may include stretching, range-of-motion exercises and strengthening exercises for the muscles that support the affected joint. Healthcare professionals often suggest physical therapy after surgery as well.

Surgery

Your healthcare professional might suggest surgery if your child:

• Has a loose piece of bone and cartilage in the joint.
• Doesn't get relief from rest and physical therapy after 4 to 6 months.

Children who have stopped growing and adults with osteochondritis dissecans also often need surgery. The type of surgery depends on the size and stage of the injury.

You might first talk with your main healthcare professional, who might send you to a doctor who specializes in sports medicine or orthopedic surgery.

What you can do

Make a list of:

• Your or your child's symptoms and when they began.
• Key medical information, including other conditions you or your child has.
• All medicines, vitamins and supplements you or your child takes, including dosages.
• Any recent accidents or injuries that might have harmed your or your child's joints.
• Questions to ask your healthcare professional.

For osteochondritis dissecans, some questions to ask include:

• What's the most likely cause of this joint pain?
• Are there other possible causes?
• What tests can help with diagnosis?
• What treatment do you suggest?
• What can I do to keep symptoms from coming back?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional may ask you questions, such as:

• Is the joint swollen? Does it lock or give out?
• Does anything make the symptoms better or worse?
• How bad is the pain?
• Have you or your child injured the joint? If so, when?
• Do you or your child play sports? If so, which sports?